A Functional Theology of Psychopathology

By E.P. Herrington

Vincent Van Gogh, "Weeping Woman," 1883

In my experience as a chaplain and as a mental health clinician I have heard unique beliefs and narratives that can make the symptoms of psychological suffering meaningful in a diagnosed person’s view of the world and God’s role in it. These functional theologies, (or theologies to support coping in individual’s daily life), sometimes respond to and challenge the meanings created for them about their mental illness by social institutions like the church, which has often impeded or injured individuals with mental disorders, reflecting ignorance and lack of curiosity about their potential to positively contribute to the church and its theology.

Mental illness often evokes a fear response from institutions oriented toward promoting “order” or safety in society—yet sadly, for individuals diagnosed with mental disorders it is more likely that they will be the victims of crime than the perpetrators. The mistreatment and avoidance of people of psychological difference keeps their experiences and prophetic witness from wider view; this condition of removal is unfortunate since the church could be deeply enriched by perspectives unavailable to neurotypical believers.

Functional theologies of individuals with mental illness are extremely diverse and sometimes incongruent with the doctrines and dogma of the various Christian denominations. It is not uncommon for people with mental disorders to experience things beyond what stable “normal” folks are capable of. These experiences, such as a suicide attempt or a psychotic break from reality, contain rich imagery that, when the individual is in a healthier place, serve as creative metaphors (such as bipolar sufferer Kay Redfield Jameson describing mixed state mania as being a horse in a burning barn) that help others understand more accurately what mental illness is really like.

The functional theology I developed after my own diagnosis is one that views God as with us but far from omnipotent. This clashes with typical Christian dogma, but in my life maintaining faith required that I reconsider God’s fundamental ability to intervene, because when I was at my worst there was no miraculous intervention of the supernatural variety described by scripture and in my Sunday school classes. I was faced with the choice, when integrating my suffering with my beliefs and call, of either abandoning God or reconsidering what God can really do in those moments. Since God also suffers, in my theological view, there is always love and grace available to me in the midst of my suffering; however, God cannot and, I have come to believe, should not intervene in human affairs.

Theologian John Sanders' book The God Who Risks, which I discovered much later, reflects much of my own functional theology. Additionally, Frank Tupper’s Scandalous Providence and his lectures at Wake Forest helped me flesh out my functional theology and understand how it fits into my Baptist faith and ministry. Frank always spoke of “3 AM questions,” those moments when, awake with worry or insomnia, we experience anguish and petition God for help. I have far fewer 3 AM questions today because I no longer expect God to intervene. Furthermore, there is great pastoral comfort in knowing my creator suffers with me. It helps me sleep at night. This is the role of functional theology in my personal experience mental illness.

Individuals with mental disorders, in the midst of acute symptoms, may not be capable of theological reflection or benefit from it. With the exception of prayer and contemplation, pastors have, for too long, attempted to manage mental illness in congregations without sufficient training and that has led to damaging interventions sometimes informed by moral judgments instead of clinical knowledge. Moralizing mental illness has been the most damaging approach, historically, taken by the church, and in many parts of the world this is still the way mentally ill individuals are viewed. The moral lens ascribes mental illness to moral defect or deficiency and sometimes demonic forces. Categorizing a person as evil or morally defective has severe effects on the way society treats them.

My goal as a provider of care to individuals with mental disorders and as one of those diagnosed with several mental disorder is to giving these voices legitimacy by granting them my confidence and trust and (when appropriate) by sharing their witness with others whom they might not currently be able to reach or influence in solidarity or support. However, this does not amount to following a psychotic individual down the rabbit hole chasing delusion after delusion. Furthermore, I am not arguing that psychosis or any symptom is itself a good thing. I believe contrarily that psychiatry and therapy need to help reduce the most acute symptoms in order for these prophetic voices to be comprehensible and authentic. I assess and treat mental disorders according to clinical knowledge and best practices, but I also try to empower my clients to speak from their social location – with the confidence that comes from others aware of how the client is managing their symptoms well. Making meaning out of mental disorders and the diagnostic experiences people endure is imperative for later thriving for that person. The main lesson I see, or the primary prophesy I have attempted to share and have heard from my clients, is that marginalized folks are profoundly misunderstood because their voices are discredited.

There is no doubt that this group of people are marginalized in society, the church, and many other societal institutions. There oppression still largely goes unrecognized. They are mostly invisible (homeless, unemployed, isolated) and may feel like second class citizens[1]—yet there are prophetic voices that share stories of great resilience, hope, despair, love and alienation among this population. I believe we can learn a great deal from the prophets in our psych wards, but when their stories or voices are suppressed or invalidated we lose this valuable learning about the human experience. Psychiatry has, in some instances, stifled their witness: over-diagnosing individuals in poverty or of a different ethnic group is an excellent example. Psychiatry also has helped these prophetic voices by providing clarity to narratives and by helping reduce symptoms that prevent them from functioning in daily life. Theologically, these stories challenge what we believe to be normal human experience and compel us to expand our ideas of God.

There is historical precedent and scriptural backing for including the narratives of those diagnosed with mental disorders in the church. God has revealed God’s self in strange ways, to seemingly strange folk, and God’s revelations carry often strange or downright offensive messages regarding morality, faithfulness, and the future. The messages of revelation and our understanding of it is less supernatural today, perhaps, but nevertheless prophetic witnesses are in our midst. What is the prophetic witness offered by the mentally disordered? What sense could that message even make if the witness is not to be believed at their word due to the presence of symptoms like delusion, paranoia, or hallucination?

The answer is that we do not know what messages these marginalized children of God can share with the rest of society because we have either invalidated their points of view or we have medicated away despair, disappointment, dissent, and disorder. The relationship between the aspects of human experience unique to those diagnosed with mental disorders and the church is quite long and well documented. Scripturally, we see these relationships as early as in the prophetic stories of Ezekiel and Jeremiah, who experienced revelatory visions of a religious nature. We see them in the practices of medieval monks self-flagellating, fasting, and isolating themselves from others in order to experience levels of suffering beyond what is “normal.” We also see it in the vivid accounts of theologian Anton Boisen who hallucinated a towering wall between medicine and spirituality and then worked the rest of his life to overcome and bridge that separation. We see it in the work of pastor Wayne Oates, whose direct engagement with the mentally disordered and the clinicians who care for them led to the creation of clinical chaplaincy or CPE in the mid-20th century.

Unfortunately, the signs and symptoms of mental disorders elicit a powerful fear response from people unfamiliar with these experiences and church-going folk can be especially judgmental and avoidant of sympathy and curiosity[2]. This anxiety and fear, when not controlled and understood, has led numerous social institutions to create policies and morays that are aversive toward and abusive of these individuals. Culturally we have begun to walk back some of these policies, and I believe religious caregivers—starting with the pastoral message of preferential treatment of the poor and marginalized found consistently across the gospel narratives about Jesus—have at many crucial junctures improved the treatment and grown broader social acceptance of mental disorders. Sadly, this is not universally true at all points and at times the church has marginalized individuals, cast them out of churches and society, and even at times explicitly persecuted them. The way I view the relationship between theology and mental health scripturally is through the lens of Jesus’ clear message about preferential treatment for the poor, oppressed and marginalized, the doctrine of the imago dei, and the prominence of the prophetic witness receiving revelation through abnormal or atypical experiences. Jesus consistently spent time among the undesirables who, by societal and religious norms of that time, were beyond help and represented what seemed to be morally or spiritually destructive forces.

Jesus’ ministry did not dispel this damaging perspective for reasons I am still trying to understand. Nevertheless, Jesus sought out these people and in the story of the demoniac of Gergesa, healed a man experiencing acute symptoms of mental illness. The man had been removed from the city he lived in, shackled in a grave yard, and left for dead. The fear that led to this man’s isolation and maltreatment was recognized by Jesus as problematic. Jesus encountered the man where he was, afflicted by a mental disorder identified as possession by the demon Legion, and healed him. Theologically this compels all ministers to reflect on their own fear and bias, and be present with people suffering from mental disorders and in great distress, or who may be exhibiting deviant or abnormal ways of thinking, feeling, and behaving. In our present day, stigmatizing beliefs persist that oppress and marginalize individuals who are among the most vulnerable. Solitary confinement—not all that dissimilar from the way the man in Gergesa was treated—still takes place for individuals with active symptoms of mental disorders and not just in underdeveloped parts of the world. The abuse of mentally ill people in prisons is rarely discussed in society and is largely ignored by the church, although there is a great deal of documentation and witness to its existence in these places unseen by those of us free to walk in the light.

It is still acceptable to forcibly commit individuals, restrain individuals, and medicate individuals against their will, often for the safety and comfort of others fearful of mental disorders. Yet, the gospel stories address not just individuals with the most acute symptoms like the demoniac; Jesus supported the marginalized wherever they were, knowing perhaps of the damaging effects of long-term invalidation, assumed inferiority, shame, and being shamed. Jesus’s work with these populations represents a message of empathy, an awareness that the impact of stigma and other people’s ignorance and fear affect people long after the symptoms of a mental disorder abate or are managed. Consistently people with mental disorders are treated as if they are incapable, untrustworthy, unprofessional, and impolite long after their symptoms abate.

There is a wealth of theological territory to explore around the relationship between the church and mental illness and sadly, much of this territory remains unknown. Therapists and ministers who strive to be “curious, not judgmental” (to quote Walt Whitman) exemplify the Jesus’s approach to people of psychological difference. Curious care informed by love makes for more compassionate treatment in the clinic, the church and society at large. We know so little about these experiences, and we have for too long attempted to censor these perspectives. A radical change in approach and perspective may be required for many pastors and clinicians, but it is certainly possible and desperately needed.

E.P. Herrington is a clinical therapist in training and has served as chaplain at three different hospitals in North Carolina and Kentucky, including Wake Forest Baptist Medical Center, Norton Hospital in Louisville and Kosair Children's Hospital.

Paul received his BA in Philosophy at Bellarmine University in Louisville in 2008 and his M. Div at Wake Forest in 2011. He was ordained at Deer Park Baptist Church in 2012; in his personal life, his ministry, and his profession as a counselor, Paul hopes to develop his skills for connecting with people and inspiring joy, faith, and facilitating an environment to speak freely.